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Fighting fentanyl in Alberta: An investigation into a public health crisis

Last Updated Sep 26, 2016 at 10:01 am MST

Alberta Law Enforcement Response Teams (ALERT)

It’s the newest serial killer, targeting communities across North America and becoming even more prevalent on the streets of Calgary.

As of June 30th, 2016, fentanyl overdoses have killed 153 people in Alberta – 67 in the Calgary zone.

This is part of a steady increase in fentanyl-related deaths in the province. Alberta Health Services reported 274 such deaths in 2015, 120 in 2014, 66 in 2013, 29 in 2012 and six in 2011. That’s a 45 times increase between 2011 and 2015, and we’re on pace to surpass last year’s record.

The numbers are similar, if not worse, elsewhere; officials reported in September that there have been 488 overdose deaths in British Columbia so far this year. Last year, 503 people died because of overdoses. While they don’t have exact numbers on what drugs are responsible, it’s believed the majority of them are from fentanyl.

In Ontario, the latest numbers from 2015 show fentanyl was the number one cause of opioid related deaths, killing a record 162 people on its own and 36 when combined with alcohol.

“We certainly have a public health crisis continuing in our city,” says Staff Sergeant Martin Schiavetta with the Calgary Police Service.

Law enforcement around the province continually make busts, such as in July of 2016 when ALERT seized 100 kg of the main ingredient of fentanyl, known as NPP, and 3200 fentanyl pills that also contained W-18, an even more powerful synthetic drug. But police have a hard time permanently plugging the flow of drugs, as most of it isn’t being made here.

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(Alberta Incident Response Team July, 2016)

“The fentanyl powder that’s coming in is being imported, mostly from China,” S/Sgt. Shiavetta adds.

This is also a new problem for the city.

Between 2004 and 2008, statistics show Calgary police didn’t deal with any significant amount of opiates. Seizures for OxyContin, morphine and methadone increased in 2012. Then suddenly in 2013, heroin use jumped by 70 per cent with an influx of prescription OxyContin on the streets

As OxyContin was being prescribed at record levels across the country, heroin use shot up along with it. In response, Purdue Pharma decided in 2011 to modify their recipe and released OxyNeo, a harder to abuse painkiller. Ontario passed legislation in 2012 to restrict access to Oxycodone, with other provinces following suit across Canada.

2016 heroin increase

However, drug dealers still innovated and found a cheaper option, leading to a current fentanyl crisis.

“Calgary has a very high rate of fentanyl abuse and addiction, and I would say we’re certainly higher than most cities in Canada.”

RCMP agree it’s hard to stop, and in a report called ‘Fentanyl and Beyond: Evolutions in the Canadian Illicit Opioid Market’, they say use and distribution of the painkiller has skyrocketed in the last year, with no signs of stopping.

Also, at the moment, it is still legal to purchase NPP, the main ingredient in fentanyl, but there is an amendment in Parliament to have it regulated under the Controlled Substances Act.

ENFORCEMENT NOT NECESSARILY THE ANSWER 

As police in Calgary and across Alberta try to stop the flow of opiates like fentanyl onto our streets, a local addictions expert doesn’t think the answer is as easy as removing the drug.

“You know if I could make all the fentanyl disappear off the streets tomorrow, not necessarily going to fix anything, the disease of addiction is still there and it’s still not changed,” says Dr. Brendan Adams. “Then you have people madly casting about for the next opiate that they’re going to use, and they may choose something even more dangerous yet.”

“One of the things that is so dangerous about fentanyl, is when you give it to someone who has the disease of addiction, it surprises them. It does something they’re not expecting it to do, because it’s 50-100 times as strong as morphine.”

Dr. Adams says the problem runs deep in the mind of an addict, and even if you take the drug out of their system, the disease telling them to use drugs remains. Therefore, they would need the services of a treatment centre, where they can access counselling services along with drug replacement programs such as methadone and suboxone.

Several issues arise when discussing treatment centres, as well. First off, they are few and far between, and some have long wait times.

At the only two publicly funded Alberta Health Services methadone clinics in Calgary, wait times range from one and a half to 6 weeks, and an addict also needs a doctor’s assessment beforehand. At private facilities, where costs are much higher, wait times are at best within 24-48 hours or at worst in a month. Plus, methadone or suboxone are not miracle cures.

“Suboxone doesn’t treat addiction,” continues Dr. Adams. “What suboxone does is it deals with the drug that your addiction is driving you to use, and the drug that is likely to kill you. So it’s very relevant, it’s very good, but then you’ve got to deal with the root disease of addiction if you’re going to get anywhere with people.”

If these issues, which Dr. Adams says can be messy and expensive to deal with, are not addressed, it opens the door for so-called dry drunks.

“The best lay description of a dry drunk I ever heard, is the guy’s so miserable you want to buy him his next drink because you just want him to chill out.”

THE STRUGGLE OF USERS

These challenges, and more, have been faced by numerous addicts in Calgary, around the province, and across the country.

Addict Tessa J., was first introduced to fentanyl by her ex-boyfriend in Port Coquitlam when she was 19.

“So I actually had the flu one time,” Tessa explains. “And he told me it would make me feel better. So I took it, and I was puking and I passed out and like, it wasn’t a good experience at first.”

Despite this, she slowly got more involved in the drug, to the point where it started making her feel good, not sick. With the addiction continuing to snowball after that.

“Waking up in the morning, needing a pill, doing it in my car on the way to work so I wouldn’t withdraw for the two hours, my life was so unmanageable that if I didn’t have it, I didn’t know what to do.”

“I was jumping back and forth between my mom’s, my dad’s, and my grandparent’s house. But then they would tell me to leave, or I would steal something from them or fraud them of some sort, do something. And so, they would kick me out, and I would go stay with another using friend or something for two weeks and then convince my family to let me back into the house. So that’s what my whole life was for about 2 and a half years there.”

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(Fentanyl pills seized by ALERT in July,2016)

While spending time with using friends, Tessa wouldn’t slow down, as they would egg each other on to continue using more and more drugs.

She attempted to detox several times on her own, but would eventually return to fentanyl, and would convince herself it wasn’t a big problem.

“I liked to think in my own head that I was a functioning addict, that I didn’t really have a problem, I was just doing it because I liked to do it.”

When Tessa was 21, her close friend died in his sleep after mixing fentanyl and alcohol…but that was not a deterrent.

“I was like, I could use all of that and not die. It was a very sick ego over it, and I thought I was better than that.”

Tessa’s aunt convinced her to move to Calgary for a change of scenery, which helped temporarily until she started making friends in Calgary’s fentanyl community, where it was much worse and she continued to use for several more months.

Eventually though, she got a spot at the Alberta Adolescent Recovery Centre in Calgary, one of the private facilities in the city that sees young people and families, usually within 24 or 48 hours. There, she got clean, and now 23-years-old, Tessa is looking ahead to the future.

“I like being able to wake up in the morning and not have to scramble for money to get drugs.”

But still, the disease of addiction remains.

“I think all addicts will have little bits of that in their life. If I could use and not have all the consequences I did and not have all this stuff going on around me, then yeah I think every addict would (continue to use). But it’s the lifestyle that’s scary, and that’s what makes me not want to go back.”

WHAT IS BEING DONE TO SOLVE THE PROBLEM 

To help combat these deaths, Naloxone Kits became available in May of this year, free of charge and without a prescription at registered pharmacies across the province.

According to Alberta Health Services, as of July 31st The Alberta Community Council on HIV dispensed 2,910 kits across the province with approximately 313 being used in overdose reversals.

naloxone kit

(Take home naloxone kit)

The Associate Health Minister Brandy Payne says the government is working on providing more resources to people in need.

“We’ve provided a 3 million dollar grant to Alberta Health Services to open more opioid replacement treatment clinics across the province. Just last May we opened a clinic in Cardston which was identified as a high need area, both Cardston itself as well as the neighboring indigenous communities. We are working to open two more clinics one in the north zone and another one in the central zone.” Payne said.

Payne adds this will not only broaden the access to life saving treatments but reduce clinic wait times as well.

She says they are working with their partners to raise public awareness and continue the conversation about addiction through outreach programs across Alberta.

However, Calgary-Mountain View MLA David Swann doesn’t think the government is doing everything they can to come up with a long-term solution.

He believes Alberta should follow in British Columbia’s footsteps and declare a Public Health Emergency.

David Swann

(Calgary-Mountain View MLA David Swann)

“Every week we need to know the numbers what the characteristics of the folks are, are they First Nation, are they new Canadians, are they teenagers, are they long standing addicts. Without knowing more of the details it’s impossible for the professionals to move the resources and provide the services to their particular conditions.”

British Columbia became the first province in Canada to declare an emergency in April of this year due to the amount of people dying from illicit drugs like fentanyl.

Swann says we need to find money in the Provincial budget or else we will continue limping along and dealing with the symptoms without getting at the root cause.

“I think the minister’s claim that she doesn’t have enough money to address the issue is a false one and we have to confront that. If she can spend 200 million dollars on renovating laundry facilities in the health system we have to find the leadership and the resources to get at the real issues of addictions and mental illness.”

He adds the stigma of mental illness and addiction continues to be a barrier for people to reach out for help and we need to confront the issue by talking about, supporting each other and have the resources readily available in our society to help repair people’s broken lives.